- CVS Health (Columbus, OH)
- …from your laptop. **Fundamental Components:** * Utilization management - The medical director will perform concurrent and prior authorization reviews with peer ... to its membership. Aetna is looking for a medical director to be part of a centralized team that...plus. **Preferred Qualifications:** Previous Experience in Utilization Management / Claims Determination with another Health Plan / Payor or… more
- ADM (Chicago, IL)
- …captive's external captive managers, regulators, and rating agency. **Job Requirements:** + Prior experience as Director of Insurance (or equivalent) at large ... **88434BR** **Job Title:** Director Insurance & Risk Management **Department/Function:** Risk Management **Job Description:** ** Director , Insurance & Risk… more
- AIG (Atlanta, GA)
- …or equivalent required. Multi-state adjuster licenses and/or JD highly preferred. + Prior claims management experience desired. + Must possess excellent ... customers to manage risk. Join us as a Complex Claims Managing Director to play your part...Analysts/Complex Directors to achieve technical excellence. + Conduct periodic claim file audits of field claims practices… more
- Travelers Insurance Company (Hartford, CT)
- …$106,300.00 - $175,400.00 **Target Openings** 1 **What Is the Opportunity?** The Director , Business Delivery is responsible for taking a high level business vision, ... broad and results from multi-year aspirational goals. The Business Delivery Director , working collaboratively with the technology leaders, is responsible for… more
- Banner Health (Tucson, AZ)
- …and innovative employment options by offering remote and hybrid work settings. As a Director , Claims Recovery Unit, you will lead a small team and support ... This position is responsible for the development, oversight, discovery, and recovery of claim overpayments. The Claims Recovery Unit (CRU) is designed to help… more
- Molina Healthcare (KY)
- …fee schedules, claims edits, and other system settings in the claim payment system. * Directs the development and implementation of contract and benefit ... knowledge of Excel + SQL knowledge preferred + Advanced knowledge of healthcare claims and claim processing from receipt through encounter submission. + Ability… more
- CommuniCare Health Services Corporate (Charleston, WV)
- …for proper documentation and will ensure that all necessary data was verified prior to billing. Additional responsibilities: + Check claim to verify correct ... growth, CommuniCare Health Services is currently recruiting for a Claims Validator / Biller to support our Central Billing...team, CBO cash posting team, Business Office Manager, Regional Director of Finance, MDS, Case Management, and others. The… more
- Humana (Columbus, OH)
- …of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations ... how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to complex clinical… more
- Commonwealth of Pennsylvania (PA)
- …a week/2 days per pay period. However, requests to telework must be sent to the Director prior to teleworking to ensure that no more than 20% of caseworkers are ... attach a copy of your college transcripts for your claim to be accepted toward meeting the minimum requirements....Unofficial transcripts are acceptable. You must attach your transcript(s) prior to the submission of your application by using… more
- University of Utah Health (Murray, UT)
- …team environment. + Performs routine and complex audits on phone calls and claims adjudication. + Researches claim processing problems and errors to determine ... that are integral to our mission. EO/AA_ + This position is responsible for auditing claims and customer service calls for UUHP. + The Claims and Customer… more
- Aspen Dental (Albany, NY)
- …Run review for each line of coverage with carrier and ensure proper handling of all claims . Under the general direction of the Director of Risk Management, the ... Cyber, Business Interruption and General Incident Review; through risk and claims by formulating, developing, and coordinating all claim -related activities.… more
- Whitney Young Health Center (Albany, NY)
- …Apply Description GENERAL RESPONSIBILITIES: Responsible for reviewing medical claims prior to submission and following up ... complex or problem claims or insurance types as designated by the Director . Reviews payer coding policies and procedures to ensure that the department remains in… more
- Kwest Group LLC (Perrysburg, OH)
- …coordinate legal review on first time/initial contracts with the senior project manager and director of operations prior to execution of an agreement by a Kwest ... estimates, schedule updates, and other necessary documents for review with the director of operations. Assist the project foremen with subcontractors and suppliers… more
- City of New York (New York, NY)
- …Within AO, exists Office of Revenue that houses SNAP-CR. They establish SNAP claims for the agency according to the Federal SNAP guidelines to recover inaccurate ... supervise staff (PAAII, PAAI, Eligibility Specialist II) involved in Claims processing. - Monitor and distribute cases in the...and SNAP only sites, Quality Control and Internal Audits prior to establishing in WMS. - Conduct day to… more
- VNS Health (Manhattan, NY)
- OverviewManages the configuration and maintenance of the claims system used to administer operations of current and new business for VNS Health Plan products. ... reports, recommendations, and updates/revisions to address existing and potential claims system issues. Works under general direction. Compensation Range:$98,200.00… more
- Humana (Springfield, IL)
- …include the Inclusa areas. + Relationship manager for 3rd Party vendors including claims processing, claim payment, post payment, clinical editing software and ... of our dynamic Wisconsin leadership team in this position as the Director , Consumer Service Operations. This position works with insurance companies, providers,… more
- Prime Healthcare (Farmers Branch, TX)
- …https://www.eeoc.gov/sites/default/files/2022-10/EEOC\_KnowYourRights\_screen\_reader\_10\_20.pdf Responsibilities The Corporate Director of Billing Optimization is ... optimization and improved metrics across the clearing houses. The Director will partner with revenue cycle and business office...are not limited to: 837 files, billing edits, clean claim rate standards, billing errors and trends, as well… more
- University of Utah Health (Salt Lake City, UT)
- …Health, Hospitals and Clinics, is seeking an experienced new Associate Executive Director for Revenue Cycle! The Associate Executive Director , Revenue Cycleis ... This roleensures seamless management of patient billing, insurance verification, claims processing, collections, health information, denials management and others.The… more
- Veterans Affairs, Veterans Health Administration (Amarillo, TX)
- …System, Amarillo, Texas is seeking a Home Base Primary Care (HBPC Medical Director -Physician) within the Geriatric and Extended Care (GEC) Service. The HBPC Medical ... Director will provide clinical care within the GEC service...subject to urinalysis to screen for illegal drug use prior to appointment. Applicants who refuse to be tested… more
- Organization of the Joint Chiefs of Staff (VA)
- …standards. Serve as Assistant Organizational Defense Travel Administrator. Informs Personnel Director of problems prior to submitting travel authorization for ... situations and various degrees or levels of security controls. Assist the Director and the Deputy Directors with resolving controversial, complex and difficult types… more